The introduction of tacrolimus and the development of the abdominal multiorgan procurement techniques allowed for the development of intestinal transplantation in the early 1990’s; indeed, with the early success of this procedure it would be possible to tailor various types of intestine containing grafts which can include other intra-abdominal organs such as the liver, pancreas, and stomach. This has been critical to the application of this type of organ transplant, given the wide scope of diseases for which replacement of the intestine may be necessary. Also, the understanding that the liver protects the intestine against rejection had been suggested by previous combinations of liver plus other organs such as the kidney. The first survivors of intestine transplantation would also go on to demonstrate the interaction (host-versus-graft and graft-versus-host) between recipient and donor immunocytes (brought with the allograft), which under the cover of immunosuppression allows varying degrees of graft acceptance and eventual minimization of drug therapy. However, included in the success of intestine transplantation survival outcomes has been the concomitant development of strategies to better manage intestinal failure (IF; describes a patient who has lost the ability to maintain nutritional support with his or her intestine and is permanently dependent on total parenteral nutrition [TPN]). This has been accomplished largely through the establishment of Intestinal Rehabilitation services, which incorporates a multidisciplinary team approach to medical and surgical care (including transplantation and corrective surgeries).

Intestinal transplantation is the standard of care for patients with intestinal failure who have significant complications of total parenteral nutrition. It is hoped that with the minimization of immunosuppression strategies currently used, the long-term survival will plateau, as occurs with other organ transplants; also, rehabilitation and quality-of-life studies have shown that >80% of survivors reach total independence from TPN and have meaningful life activities.

As a result of the success of intestinal transplantation, multidisciplinary intestinal centers have focused on intestinal rehabilitation and improving the devastating effects of TPN on the liver.